The larynx, or voice box, is a complex organ in the neck that serves multiple functions. It acts as an air passageway, connects the throat to the windpipe, and houses the vocal cords for sound production. The larynx also uses the epiglottis to close the airway during swallowing, preventing aspiration. A laryngectomy is a surgical procedure involving the removal of either a part or the entire larynx.
Defining the Laryngectomy and Its Primary Purpose
A laryngectomy is performed when the larynx is severely damaged or diseased. The most frequent reason for this surgery is laryngeal cancer. When the tumor is advanced, has spread significantly, or has recurred after non-surgical treatments, a laryngectomy becomes the primary method for disease removal.
The procedure may also be considered for other severe conditions, such as irreversible trauma or extensive radiation necrosis following previous cancer treatment.
A laryngectomy is sometimes performed for chronic aspiration, where the patient is unable to protect the airway, leading to recurrent pneumonia. Removing the larynx creates a permanent separation between the trachea and the esophagus, ensuring food and liquids cannot pass into the lungs.
Understanding the Types of Laryngectomy
The extent of the surgery depends on the size and location of the disease, leading to two main categories: partial and total laryngectomy. A partial laryngectomy removes only the cancerous portion, preserving the remaining structures. This approach is reserved for smaller tumors and allows the patient to retain some or all of their natural voice and swallowing function.
Variations include a hemilaryngectomy (removing one side) or a supraglottic laryngectomy (removing the area above the vocal cords). Since a portion of the larynx remains, the airway connection is preserved. Patients usually breathe normally through the mouth and nose once the surgical site has healed.
A total laryngectomy involves removing the entire larynx, including the vocal cords and surrounding cartilage. This procedure is necessary for larger, more aggressive tumors. The trachea is permanently redirected to an opening in the neck, creating a stoma. This separation of air and food passages changes breathing and makes voice restoration necessary.
The Surgical Process and Immediate Post-Operative Care
The laryngectomy operation is performed under general anesthesia. The surgeon makes an incision in the neck to access and remove the affected tissue. In a total laryngectomy, the windpipe is stitched to the skin at the base of the neck, creating a permanent opening called a stoma. This stoma becomes the patient’s only airway for breathing.
In the immediate post-operative phase, patients are admitted to a monitored setting for a hospital stay lasting one to two weeks. A nasogastric (NG) feeding tube is placed to ensure nutrition while the surgical site heals. This temporary measure allows for rest of the pharynx and is usually removed once swallowing is deemed safe.
Post-operative care involves managing pain and observing the surgical site for signs of infection. A specific risk is the formation of a pharyngocutaneous fistula, an abnormal connection allowing saliva to leak from the throat to the skin. Intensive nursing care includes frequent stoma suctioning to clear mucus and ensure a patent airway.
Adapting to Life After Laryngectomy
The most profound change following a total laryngectomy is the permanent alteration of the airway, requiring specific long-term care. Since inhaled air bypasses the nose and mouth, it is no longer naturally filtered, warmed, or humidified. To compensate, patients use a Heat and Moisture Exchanger (HME) system, a small filter placed over the stoma.
The HME traps heat and moisture from the exhaled breath and transfers it to the next inhaled breath. This helps reduce coughing and excessive mucus production. Consistent HME use is important for pulmonary health and rehabilitation. Stoma care also involves daily cleaning and suctioning at home to manage secretions and prevent airway blockage.
Restoration of communication is a primary focus of rehabilitation, as the natural voice is lost. Speech-language pathologists work with patients on three methods of voice restoration.
The most common method is a Tracheoesophageal Puncture (TEP), where a small, one-way valve (voice prosthesis) is surgically placed between the trachea and the esophagus. Air is diverted from the lungs into the esophagus, causing tissue vibration to produce sound, which is then shaped into speech.
Alternative methods include using an electrolarynx, a battery-operated device held against the neck that creates a vibratory sound. Individuals may also learn esophageal speech, which involves trapping and releasing air in the upper esophagus to create sound. Swallowing remains, but adaptation can sometimes lead to an initial loss of taste and smell, linked to airflow changes.